3rd Spanish Interoperability Forum

Towards national Electronic Health
Imaging Record
Manuel Vegas
GE Healthcare IT
May 8t...
Electronic Health Imaging Record

2
HCE de Imagen
10/8/2013
Year 2020
A dutch tourist, with a recent hip replacement, is on holidays
enjoying Alicante’s Costa Blanca

3
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Year 2020

“The replacement has moved”

4
HCE de Imagen
10/8/2013
Year 2020

“An urgent re-intervention is needed"
5
HCE de Imagen
10/8/2013
Year 2020
They plan toghether
the re-intervention

6
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10/8/2013
Nowadays
“Imaging Islands"

7
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10/8/2013
(*) EUROPEAN COMMISSION: eHealth Benchmarking III. SMART May 2011

Nowadays
Infrastructure

PACS:
82% spanish hospitals *
...
Nowadays
Obstacles

Tecnological

Organizative/
Semantic

Architectural/
Standars

Economic/
Efficiency

9
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1...
Solution
IHE

IHE XDS profile

IHE XDS-I profile

10
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10/8/2013
PIX

Solution
Profile IHE XDS/XDS-I
Standards:
Web Services

ATNA

Consistent
Time

Patient
identification
Patient identif...
Solution
“Plug-in” interoperability model

12
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10/8/2013
A strategic opportunity for the MoH
− Consolidation of all clinical documents and
medical imaging generated by all the reg...
A technical opportunity for the MoH
− IHE XDS/XDS-I based and plug-in model
− DICOM/non-DICOM imaging and clinical
documen...
· National registry and affinity domain
· Unique Patient Identifiyin (CIP-SNS),
IHE PIX based

Privileges-based
universal ...
Solution
Use case
Valencia
Region

Document
Query

MoH

Document Retrieval

MPI
MoH

XDS
Adaptor

Repository
Valencia regi...
XDS Repository
Vendor Neutral Archive level 4
Infrastructure and Information Sharing

Enterprise
DICOM Archive
Departmenta...
XDS/XDS-I consumer
Desired characteristics

Web Technology

Zero-footprint and browser-agnostic

Imaging and docs history
...
Centricity Patient Information Viewer
Web zero-footprint integrated access

Advanced
filters

History

Images and
reports ...
Centricity Patient Information Viewer
Acceso web zero-footprint integrado

Imagen Patológica
–Zona de interés
20
ECG Jpeg ...
Centricity Radiology Mobile Access
Native App to access from mobile devices

Native apps iOS + Android
Diagnostic quality ...
Experience across the globe
Neutrality

Scalability

• Connected to Agfa, Carestream,
McKesson, Sectra, Siemens, Phillips,...
South Western Ontario
(Canada)
Objective
• Connect care providers
• Central repository of images and reports for instant
a...
Antwerp University Hospital
(Belgium)
Objective
• Consolidate information from different
departments (radiology, cardiolog...
Västra Götaland region
(VGR, Sweden)
Objective
• Central repository of images and reports
• Immediate access to prior imag...
NHS Wales (UK)
Objective
• Improve oncology and cardiology treatment
• Share radiology data across legacy RIS/PACS
• Repla...
Ile de France (France)
Objective (regions sans film)
• Leapfrog Paris region to HIT
• Sharing imaging results
• Improve ca...
Southern and
NWWM Clusters (UK)
Objective
• Connect the radiology departments across
communities
• Central long term archi...
University Hospital Antwerp
(UZA - Belgium)
Objective
•

•
•
•

Enterprise-wide repository for medical imaging
(radiology,...
DICOM

proprietary

HL7

UZA Solution Overview

XDS
EPD C2M
(EMR) client

HIS/EMR
Patient demographics (HL7 ADT)

RIS (GE)...
Building bridges …

¡Thank you very much!

31
HCE de Imagen
10/8/2013
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Seis hce imagen_final_english

  1. 1. 3rd Spanish Interoperability Forum Towards national Electronic Health Imaging Record Manuel Vegas GE Healthcare IT May 8th, 2013
  2. 2. Electronic Health Imaging Record 2 HCE de Imagen 10/8/2013
  3. 3. Year 2020 A dutch tourist, with a recent hip replacement, is on holidays enjoying Alicante’s Costa Blanca 3 HCE de Imagen 10/8/2013
  4. 4. Year 2020 “The replacement has moved” 4 HCE de Imagen 10/8/2013
  5. 5. Year 2020 “An urgent re-intervention is needed" 5 HCE de Imagen 10/8/2013
  6. 6. Year 2020 They plan toghether the re-intervention 6 HCE de Imagen 10/8/2013
  7. 7. Nowadays “Imaging Islands" 7 HCE de Imagen 10/8/2013
  8. 8. (*) EUROPEAN COMMISSION: eHealth Benchmarking III. SMART May 2011 Nowadays Infrastructure PACS: 82% spanish hospitals * EHR: 94% spanish hospitals * Broadband connectivity: 92% european hospitals * 8 HCE de Imagen 10/8/2013
  9. 9. Nowadays Obstacles Tecnological Organizative/ Semantic Architectural/ Standars Economic/ Efficiency 9 HCE de Imagen 10/8/2013
  10. 10. Solution IHE IHE XDS profile IHE XDS-I profile 10 HCE de Imagen 10/8/2013
  11. 11. PIX Solution Profile IHE XDS/XDS-I Standards: Web Services ATNA Consistent Time Patient identification Patient identification feed HL7 Query documents Consumer Registry DICOM Register documents Source Image Manager Provide and register documents Repository Retrieve documents · Image retrieve · WADO retrieve 11 HCE de Imagen 10/8/2013
  12. 12. Solution “Plug-in” interoperability model 12 HCE de Imagen 10/8/2013
  13. 13. A strategic opportunity for the MoH − Consolidation of all clinical documents and medical imaging generated by all the regions in Spain and the private health centers − Centralized master registry owned and managed by the MoH − Plug-in model: Any entity can be added to the exchange, given it implements the interoperability contract (XDS based) 13 HCE de Imagen 10/8/2013
  14. 14. A technical opportunity for the MoH − IHE XDS/XDS-I based and plug-in model − DICOM/non-DICOM imaging and clinical documents (structured/unstructured) in a common index − National registry and affinity domain, defined and managed by the MoH − Universal multi-device web access − Cloud and SaaS paradigms 14 HCE de Imagen 10/8/2013
  15. 15. · National registry and affinity domain · Unique Patient Identifiyin (CIP-SNS), IHE PIX based Privileges-based universal access from any point of the Spanish geography. With total audotory and compliance with data protection regulations 15 HCE de Imagen 10/8/2013
  16. 16. Solution Use case Valencia Region Document Query MoH Document Retrieval MPI MoH XDS Adaptor Repository Valencia region EHR Document Provisioning Plataforma de Integración Study Registration Study Registration Registry MoH Document Registration Repository MoH
  17. 17. XDS Repository Vendor Neutral Archive level 4 Infrastructure and Information Sharing Enterprise DICOM Archive Departmental Archive Multi-PACS, cardiology Enterprise Multi-specialty Archive Multi-institution Patient Information Management Multi-PID, patient consent, gateway to image exchange Connecting to ‘ologies, enterprise registry DICOM Archive Level 1 (DICOM) Level 2 (DICOM) Level 3 (+XDS) Level 4 (+XDS) Independence of PACS application Imaging consolidation across enterprise Enterprise-wide clinical data consolidation Cross-enterprise patient repository & sharing 17 Centricity Clinical Archive overview 10/8/2013
  18. 18. XDS/XDS-I consumer Desired characteristics Web Technology Zero-footprint and browser-agnostic Imaging and docs history Mobile 18 HCE de Imagen 10/8/2013
  19. 19. Centricity Patient Information Viewer Web zero-footprint integrated access Advanced filters History Images and reports viewer 19 HCE de Imagen 10/8/2013
  20. 20. Centricity Patient Information Viewer Acceso web zero-footprint integrado Imagen Patológica –Zona de interés 20 ECG Jpeg de Imagen HCE 10/8/2013
  21. 21. Centricity Radiology Mobile Access Native App to access from mobile devices Native apps iOS + Android Diagnostic quality (retina) Streaming (WiFi + 3G) 21 HCE de Imagen 10/8/2013
  22. 22. Experience across the globe Neutrality Scalability • Connected to Agfa, Carestream, McKesson, Sectra, Siemens, Phillips, Ramsoft • Multidimensional (format, storage, access) • 60 M studies • 3 Bn images • 1 Petabyte South Western Ontario LSP, England Very large archive VNA & integrated workflow Cloud friendly Standards • Cloud based archive and PACS • Pay as you go • Hosted environment • XDS infrastructure • GE active member of standardization Ile De France VGR, Sweden Cloud PACS + results sharing VNA + integrated access 22 Centricity Clinical Archive overview 10/8/2013
  23. 23. South Western Ontario (Canada) Objective • Connect care providers • Central repository of images and reports for instant access, and exchange • Improve care provider productivity • IT infrastructure cost savings • Reduce patient transfers and duplicate scans • 62 hospital locations across the region Solution • 19 hubs with separate RIS/PACS systems • Central repository and information access • 12 different RIS/PACS vendors • Hardware redundancy and disaster recovery • 3.2 million exams/year • High availability with dual data centers • 1600+ system users 23 Centricity Clinical Archive overview 10/8/2013
  24. 24. Antwerp University Hospital (Belgium) Objective • Consolidate information from different departments (radiology, cardiology, nuclear medicine and other sources such as Olympus Endobase) • Access to DICOM and non-DICOM data • Give consolidated access to patient information • Lower cost of IT management Solution • A multi-ology information repository • IHE Standards based solution • 600 bed hospitals • 500k exams per year • Heterogeneous departmental IT systems (GE PACS, Agfa cardiology, Olympus Endobase) • 50 modalities directly connected • Consolidated view of patient information • Virtualized environment 24 Centricity Clinical Archive overview 10/8/2013
  25. 25. Västra Götaland region (VGR, Sweden) Objective • Central repository of images and reports • Immediate access to prior images and reports from the whole region • Primary viewing platform outside imaging • Improved imaging workflow Solution • Common repository across 17 hospitals • IHE standards • Sweden’s second largest region • 1.5 million residents • 17 hospitals • Heterogeneous RIS/PACS systems • Web access to images and reports • ASP model since 2006 25 Centricity Clinical Archive overview 10/8/2013
  26. 26. NHS Wales (UK) Objective • Improve oncology and cardiology treatment • Share radiology data across legacy RIS/PACS • Replace patient CD workflow • Avoid redundant exams • Improve coverage of rural areas Solution • A patient centric document repository • 4.5 million patients • 13 multi-vendor systems • IHE-XDS & DICOM to connect multi-vendor systems • Connected to Welsh Master Patient index • Web portal for multi-disciplinary teams • Starting with oncology network • Hosted deployment model 26 Centricity Clinical Archive overview 10/8/2013
  27. 27. Ile de France (France) Objective (regions sans film) • Leapfrog Paris region to HIT • Sharing imaging results • Improve care quality through collaboration • No more film or CD by 2012 • 12 million patients, 500+ radiologists Solution • 30 hospitals growing to 90 • Standards based information repository • Multi-vendor RIS-PACS systems (PACS: carestream, Telemis, GE; RIS: EDL, Waid, home grown) • Data center • 24 x 7 high availability service • SAAS model – pay per use • Standards Compliance (DICOM, IHE, HL7) 27 Centricity Clinical Archive overview 10/8/2013
  28. 28. Southern and NWWM Clusters (UK) Objective • Connect the radiology departments across communities • Central long term archiving of all imaging data with HA and DR • Enable access of images to physicians and specialist Solution • Cloud deployment of imaging repository • Dual data centers, virtualization • Business continuity & DR solutions • Central archive for 74 different PACS instances • Central archive ~60 million exams • 40% of England covered: 20M patients, 72 NHS trusts • Delivered average uptime of 99.98%** ** As reported by NHS Connecting for Health for the period August 2009 to July 2011 28 Centricity Clinical Archive overview 10/8/2013
  29. 29. University Hospital Antwerp (UZA - Belgium) Objective • • • • Enterprise-wide repository for medical imaging (radiology, cardiology, etc.) and scanned documents Migration of proprietary scanned documents archive to XDS standard Image viewer for all clinicians contextintegrated to EMR Consent management • 600 beds hospitals Benefits • • Helps to facilitate the replacement of departmental workflow solutions Longitudinal patient record that facilitates access to relevant clinical information across departmental boundaries • 500 k exams per year • Heterogeneous departmental IT systems ( GE PACS, Agfa cardiology, Olympus Endobase…) • 50 modalities directly connected 29 GEHCIT CCA EMEA Overview 10/8/2013
  30. 30. DICOM proprietary HL7 UZA Solution Overview XDS EPD C2M (EMR) client HIS/EMR Patient demographics (HL7 ADT) RIS (GE) Patient demographics (HL7 ADT) PACS (GE) Patient demographics (HL7 ADT) and orders (HL7 ORM) DICOM data Patient demographics Document scanning User and patient context integration (client-side) PDF documents with meta data (e.g. HL7 MDM) Non-DICOM data with meta data (e.g. video) Cardio PACS (Agfa) New DICOM exams Radiology long-term archive Gastro + other ologies CVIS (Agfa) Patient demographics (HL7 ADT) and orders (HL7 ORM) Patient demographics (HL7 ADT) New DICOM exams Other ology DICOM archive Cardio longterm archive Publish final Publish image references to XDS reports to XDS Publish image references to XDS EA XDS adapter Publish objects to XDS Publish image references to XDS XDS/XDS-I Document Repository Patient demographics (HL7 ADT) Register objects in XDS repository: HL7-CDA, PDF, DICOM image references, JPEG, video, etc. Caradigm XDS Document Registry (central index) Document and Image Access Query registry Cweb PIV XDS viewer Centricity Web DICOM viewer 30 GEHCIT CCA EMEA Overview 10/8/2013
  31. 31. Building bridges … ¡Thank you very much! 31 HCE de Imagen 10/8/2013

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